PROJECT SUMMARY The overall goal of this proposal is to leverage existing and new partnerships and infrastructure to develop a unified, country-wide, population- and clinic-based Regional Center for Research Excellence (RCRE) dedicated to the prevention and control of non-communicable diseases (NCDs) in India. The research infrastructure will include three shared core resources (biorespository/laboratory, data management, and field data collection), and research enhancement training to build capacity (basic science fellows, tumor registrars, and research support personnel). These infrastructure components will be applied over time to three demonstration projects. Over the past five years our team has developed four large-scale, well-phenotyped, bio-banked, geographic information systems (GIS)-linked population-based cohorts with data on NCD risk factors and outcomes. Individually, these cohorts are not sufficient in size to evaluate cancer incidence and outcomes, but if combined, these cohorts with over 150,000 person-years of follow-up to-date offer a timely and robust platform to fulfill local cancer and NCD research priorities. The RCRE will be developed in phases by achieving short-, mid- and long- term planning objectives involving different geographic areas. The 2-year short term (Phase I) objective will focus on New Delhi (National Capital Territory) in the north and Chennai (Tamil Nadu State) in the south to efficiently build on our longitudinal Center for Cardiometabolic Risk Reduction in South Asia (CARRS) Surveillance Study cohort and linkable population-based cancer registries located in these two cities. The mid-term (Phase II) objective (2-5 years) is to expand RCRE activities to 2 additional cohorts representing 3 more states with varied levels of urbanization. The long-term (Phase III) objective (5-10 years) will be to expand the RCRE activities nationwide, starting with the 10-site DISHA study, and eventually to other countries of the region, including, but not limited to, Bangladesh, Nepal, and Sri Lanka. The RCRE is co-led by Emory University (HIC), and Public Health Foundation of India (PHFI) and Research Triangle Institute (RTI) India, in partnership with several regional organizations including Madras Diabetes Research Foundation, All India Institute of Medical Sciences (AIIMS), Cancer Institute (WIA), and the Delhi and Chennai Cancer Registries. RCRE activities will be overseen by a Steering Committee, guided by a Scientific Advisory Group, and stimulated by a Community Collaborative Board comprising diverse, NCD-focused global, national- and state-level stakeholders. We focus on three high priority NCDs in India - breast cancer, oral cancer, and diabetes mellitus. Follow completion of the planning phase the research focus will further expand to include other high-burden, emerging or previously neglected NCDs including mental health problems, cardiovascular diseases and stroke, colorectal cancer and cancers of the cervix, gallbladder, upper gastrointestinal tract and lung.